When is it OK to share information about a patient's healthcare with his family or friends? What topics are permitted and what's off limits?

The U.S. Department of Health and Human Services has issued a fresh set of guidelines to help healthcare providers navigate the sometimes murky waters of the HIPAA Privacy Rule in terms of disclosing patient information to friends, family members and others involved in the patient's care. The new guidance is presented in a Q-and-A format and "is intended to clarify these HIPAA requirements so that healthcare providers do not unnecessarily withhold a patient's health information from these persons," explains the department's Office of Civil Rights.

According to the guide, healthcare providers may discuss patient information with others in the following situations:

when the patient gives his consent or does not object when given the opportunity; and

when the patient is not present or is incapacitated, but the healthcare provider has determined that communicating with another person is in the patient's best interest.

The guide points out that healthcare providers may only discuss information that is related to the patient's current condition or payment for care, not information about past medical problems. Information may be shared face to face, on the phone or in writing, and providers are allowed to exercise their professional judgment in allowing friends and family members to pick up prescriptions, X-rays or other items for the patient.

The Office of Civil Rights offers additional information on the privacy rule on its Web site. It has also issued a separate set of HIPAA guidelines geared toward patients.

Thanks to a four-year-old conservation effort, the ORs at Oregon Health and Sciences University in Portland now recycle 300 pounds of uncontaminated paper and plastic every day and save about $40,000 in electricity each year.

Without compromising the facility's infection control practices, wrappers and packaging material for surgical instruments, suture material and gauze pads go directly into a recycling bin.

"They are no-brainers for recycling because they are never contaminated," says Juliana E. Hansen, MD, FACS, the university's chief of plastic surgery, in a press release. "They are never handled by the surgeons. They are opened sterilely and removed from surgical products before being used in an operation."

Dr. Hansen and her colleagues presented the results of the university's "green OR" program at the American College of Surgeons' annual meeting in San Francisco last week. The program is part of the university's environmental sustainability program, which recycled nearly 1,100 tons of solid waste and saved more than $85,000 in waste management fees in 2007.

Twenty-one ORs were refitted with energy-efficient LED lights and low-mercury lamps to reduce electricity usage. The university also purchases electricity generated from sustainable sources and uses cleaning supplies that meet the standards of Green Seal, a non-profit organization that certifies products with minimal environmental impact.

Dr. Hansen began the green OR program in 2004 after noticing how much waste even the simplest procedures generated. "Just because we are dealing with life-and-death issues doesn't mean that we have to stop thinking about the environment," she says.

A Providence, R.I., hospital will overhaul its wrong-site surgery prevention protocol in the wake of a state health department investigation that found several deficiencies that led surgical staff to operate on a patient's incorrect knee during elective surgery last month.

Miriam Hospital has signed a consent agreement with the state department of health, vowing to:

fix several problems related to its time out process, including visually inspecting the surgical site during the time out;

use indelible ink pens for marking the surgical site to ensure the mark won't wash off when the patient is prepped;

verify the original source of information with regards to the surgery and site;

hire a consultant to evaluate the hospital's policies and protocols for compliance with national best practices in safety and clinical outcomes; and

design and implement a near-miss reporting program for its staff.

"It is critical that all physicians, nurses and healthcare staff in operating rooms understand the importance of the time out process and that it is not just an administrative function," says David R. Gifford, MD, MPH, Rhode Island's director of health, in announcing the consent agreement.

The incident at issue occurred on Sept. 19, when a 60-year-old woman underwent arthroscopic surgery at Miriam Hospital's outpatient surgical center to repair a tear in her left meniscus, according to a report in the Providence Journal. Shortly before surgery, the surgeon met with the patient and correctly marked her left knee with the word "yes." However, a nurse failed to look for the mark and mistakenly prepped the wrong knee for surgery.

New hospital accreditor CMS has approved DNV Healthcare as a deeming authority for U.S. hospitals, making it the third national accreditation organization for hospitals alongside the Joint Commission and the American Osteopathic Association's Healthcare Facilities Accreditation Program. DNV's hospital accreditation program, National Integrated Accreditation for Healthcare Organizations (NIAHO), has already accredited 27 hospitals in 22 states.

Mandatory overtime banned in Pa. Pennsylvania nurses will no longer be required to work overtime, thanks to last week's passage of House Bill 834. The new legislation means healthcare facilities cannot require employees to work in excess of an agreed to, predetermined and regularly scheduled daily work shift. Nurses cannot be discriminated against or dismissed if they refuse to work in excess of their defined work shifts, according to the bill. The ban on required overtime does not, however, apply to on-call time, unforeseen emergent care requirements, the assignment of additional work hours as a last resort and the completion of a procedure or patient care already in progress.

Surgery best for carpal tunnel Surgical treatment for carpal tunnel syndrome is more effective at relieving the pain, tingling and numbness of the condition than splinting, according to research published in The Cochrane Library. A team of Chilean researchers reviewed four studies involving 317 patients with carpel tunnel syndrome, discovering that patients who underwent surgery rarely returned for a second procedure while many who initially attempted to treat the condition with medications and splinting eventually opted for surgical intervention to relieve discomfort. The researchers caution, "Further research is needed to discover whether this conclusion applies to people with mild symptoms and whether surgical treatment is better than steroid injection."